Having a hard time finding physicians who are willing to step away from treating patients with an individual-level focus? Why not dip into the doctors who are coming out of a population health school?
Universities increasingly are training doctors to treat patients as a group. The University of New Mexico and University of Wisconsin have four-year programs. Brown University is taking it to the next level, with a focus on primary care coupled with population health.
"It is the future. We're going to have to change our medical education, at least in part, to address the changes that have to occur in this country," says Edward Wing, M.D., dean of medicine and biological sciences at Brown's Alpert Medical School.
Like other medical schools, Wing says Alpert has had difficulty getting students to pursue primary care. With an average student debt load of $160,000, it makes more economic sense for docs-in-training to go into specialties, where they can sometimes earn as much as four times more in salary than they would in primary care. But Brown officials felt the school needed to start emphasizing the "future of health care" by focusing on outcomes, quality and cost. A report from the Institute of Medicine last year touted the need to marry primary care and public health, which historically have operated independently. The report helped to influence Alpert to create the new degree program, Wing says.
Alpert will offer a four-year program starting in 2015, which will earn students a doctor of medicine degree plus a master's degree. It will start small, with just 24 students per class, on top of the school's current class total of 120 students. Students will graduate with expertise in primary care, along with skills in how to address such population health issues as obesity, substance abuse and prenatal care.
While other medical schools have tried their hand at population health, Alpert's program may be unique in its integration of four elements that exist individually in many programs, but are rarely brought together, says Malika Fair, director of public health initiatives for the Association of American Medical Colleges. They include a link between population health principles and medical education, a focus in primary care, a longitudinal clerkship program, and a four-year length.
Fair thinks more schools will dive into population health in the near future as hospitals profess their appetite for such expertise. "As the nation faces shortages in primary care, as we figure out how to work better in teams and cut costs and provide more effective but less expensive care, there are going to have to be programs like this across the country," she says.
At Duke University, faculty have been surprised by the enthusiasm students have shown for curriculum built around population health, and the innovative ideas they have for bettering care, says Lloyd Michener, M.D., chairman of the department of community and family medicine. Michener, who was involved with the IOM committee that created the primary care public health report, thinks Alpert's program is notable and could provide a model for other schools down the line.
"It's harder to change a curriculum, and what makes Brown so interesting and exciting to me is that they're taking a traditional school and actually changing it to this model," he says. "That really demonstrates leadership and forward thinking."